Certification Regarding Tobacco or E-cigarette Use
or electronic cigarettes within the last six months or if I (or any of my covered dependents) start using tobacco products or electronic cigarettes subsequent to the date of this certification without notifying PEBA, I will be subject to penalties including, but not limited to, payment of premium difference since last ...
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RETIREE NOTICE OF ELECTION (NOE) R SOUTH CAROLINA …
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